1. 1 Engagement with Young People and their Carers Manchester Mental Health & Social Care Trust

2. 2 Aims & Objectives For participants to gain an understanding of the importance of therapeutic relationships. To enhance an awareness about the key ingredients of successful engagement which lead to effective therapeutic relationships To investigate the skills needed to communicate effectively with clients exhibiting a range of psychotic symptoms.

3. 3 Engagement with Young People Experiencing Psychosis Engagement can be considered in two parts: 1. The ability to be flexible and opportunistic when offering intervention to young people who may be reluctant to want to talk to you 2. The ability to establish and maintain SAFE & CONSISTENT ways of communicating with the young person, their carers / families and their wider social networks

4. 4 Engagement with Young People Experiencing Psychosis The principles that underpin engagement with this group are: Being able to work collaboratively Being empathic and non-judgmental Being prepared to give accurate and honest information and feedback Taking time to engage according to the client’s needs rather than your own

5. 5 What stops young people engaging with services? If the client has a long period of untreated psychosis If their first contact with services is through a a service which does not seek their engagement but enforces them to cooperate. This is often in a crisis such as A&E, contact with criminal justice system. Services which insist on imposing assessment and treatment on young people who disagree that they need them

6. 6 Skills of Good Communication What are the essential skills to good communication?

7. 7 What helps? Hang on in there! Try to keep meeting up with the young person, if only for a cup of coffee - but try to make this a regular event Address the needs that the client is telling you she has - benefits, housing, transport, relationships issues Be flexible enough to offer to ‘pick up the pieces’ should a crisis occur BE THERE when and if they eventually request help with their psychosis

8. 8 Important skills The relationship skills of individual workers are critical (Smith 2003): You need to be - A good communicator Able to be at ease and relaxed Able to display a good sense of humour Able to keep an optimistic & hopeful outlook Respectful of differences in others and non- judgmental Able to see clients as ‘normal’ people coming to terms with the effects of psychosis

9. 9 Developing rapport & trust Give plenty of time initially Spend time talking to clients about their interests and give something of yourself Be as flexible as possible Give notice if you are late or need to rearrange appointments Always use the same room or a room that is familiar to them Avoid bleeps and telephone calls

10. 10 Talking to people who are paranoid Evidence suggests that people who are psychotic are unable to interpret discrete body language cues. More overt non verbal cues such as smiling frequently might help Ensure that you tell the clients about the respect that you have for them Do not start by asking too many questions Distance yourself from threatening situations Look for practical ways of assisting clients

11. 11 Empathise With Feelings Look at the feelings behind unusual beliefs. Try to imagine what it would be like if what they are telling you is in fact true. Imagine the situation afresh when you see someone who has ongoing unusual or strange beliefs. Be cautious of using humour to test out a belief.

12. 12 Try to talk naturally Try not to ask questions that imply doubt. Consider the tone or stress put on significant words. Try to hold onto your own ideas and disbelief. Your body language gives it away if you do not believe something they tell you. When you don't understand what is being said, ask them to try and explain what they want to tell you in a different way.

13. 13 Know when to back off! Don’t be confrontational Be cautious when recapping as the strength of convictions or beliefs can change over time Strong challenges can cause clients to look for more arguments to support their belief Avoid too much eye contact Consider changing the environment

14. 14 Giving a Rationale Giving a reason why you want to talk with someone helps them to feel more in control Try to make sure that the person is fully aware of what is happening Giving people reasons or rationales for interventions helps maintain the atmosphere of empowerment and collaboration This process should also allow for the person to discuss any misconceptions or misunderstandings or ask questions

15. 15 Developing Trust In groups of three, use the accompanying exercise sheet. The object of this exercise is to encourage someone who is psychotic to visit their GP

16. 16 Engaging families and carers Relatives of clients are often suspicious of mental health services and reluctant to take ‘on board’ the onset of a serious mental illness. It is important to engage with relatives/ carers by providing appropriate information and to give them the opportunity to ask questions.

17. 17 Carers Assessments All carers have a right to an assessment of their own needs according to the Carers Act 1995 The National Service Framework for Mental Health (DOH 1999) states that carers should have an assessment of their own needs and access to a wide range of support systems

18. 18 Engaging families and carers Families need to be taken seriously and informed of the illness, the issues concerning the problems that arise when the illness is left untreated and the treatments available It is often helpful for ‘first time ‘ carers to have an opportunity to meet others. Putting them in touch with carers groups can be very helpful Parents have referred to the acceptance of severe mental illness as almost like a ‘grief process’

19. 19 Conclusion Working with people with mental health problems is challenging and requires good communication skills. The environment in which the therapy takes place is an important consideration. Specific skills can enhance the process of engagement. It is essential to provide reasons or rationales when trying to engage with people It is essential to engage with both the young person and their carers